Provider Demographics
NPI:1376706994
Name:EDUCATE 4 WELLNESS
Entity Type:Organization
Organization Name:EDUCATE 4 WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSING & HEALTH EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:213-842-5811
Mailing Address - Street 1:PO BOX 56589
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-0089
Mailing Address - Country:US
Mailing Address - Phone:213-842-5811
Mailing Address - Fax:
Practice Address - Street 1:10813 TUMBLEWEED RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-3628
Practice Address - Country:US
Practice Address - Phone:213-842-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554547251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)